Activity monitors are step in the right direction

1of 4Sam McQuillin, 29, logs steps on his Fitbit by pushing son ﻿Walker, 17 months, in his stroller at a park near his home. McQuillin's daily goal is at least 10,000 steps.﻿Photo: Jerry Baker, Freelance

2of 4Sam McQuillin, 29, walks while pushing his son Walker, 17 months, in his stroller at a park near his home in the Fall Creek subdivision in Humble on Friday.Photo: Jerry Baker, Freelance

Sam McQuillin works a sedentary job. The endless hours sitting at a desk took a toll on his health and fitness, he said.

Until Fitbit came into his life in July, he never thought about how little he walked. Now, his daily goal of 10,000 steps challenges him to move, and the device's app allows him to see how he ranks against his competitive friends and family.

"I can get on my phone and see who has more steps during the day, me or my brother," McQuillin said. "We've always been competitive, and we both have sedentary jobs and newborn kids, so we can see if we're actually out moving, which I like."

Worn on the wrist, Fitbit tracks steps taken, and once you've reached the daily 10,000-step goal it vibrates in congratulations, a motivational technique that seems to work for users like McQuillin.

Lifestyle activity monitors, like the Fitbit, have skyrocketed over the past few years as a simple method for keeping track of at least one health indicator: exercise.

Researchers from the University of Texas Medical Branch in Galveston studied 13 of the most popular wearable lifestyle activity monitors to study the effectiveness of behavior change techniques. Elizabeth Lyons, senior author and assistant professor at UTMB's Institute for Translational Sciences, was the lead researcher on this study.

"We tested all of the monitors available (late last year) that fit our criteria for a lifestyle-oriented monitor - that is, we did not include monitors intended to measure only individual bouts of activity," Lyons said. "They all had to measure activity across the entire day. We decided to study them because we are currently using one type, the Jawbone Up24, in a trial."

Lifestyle monitors increase functionality of standard pedometers and offer much more feedback, according to Lyons. Measuring activity can be challenging without the assistance of some type of monitor.

"I like to say that you can't fix what you don't know is broken, and a lot of people don't know just how broken their lifestyles are," Lyons said. "Just wearing a monitor for a few days can be really eye-opening."

In this study, three researchers wore the monitors for at least one week. They compared the content of the monitor to behavior change techniques such as prompt practice, goal setting and feedback.

The immediacy of feedback of the devices proved to be the most crucial element in effecting change.

"Once you've set a goal, you need to know how close you are to reaching it," Lyons said. "In addition to creating awareness of the need for change, the monitors create a metric by which change can be measured."

When McQuillin gets home after a long day at the office, he often realizes how sedentary he was when he checks his Fitbit.

"It motivates me in the sense that it gives me feedback," he said. "Most people want to be healthy, and some people probably think they're doing well, but this lets you know."

The study was less concerned with whether each person reached their steps goal and more interested in how having a goal facilitates change. Feedback from the monitors motivates the user to work harder; therefore, he is more likely to see change.

"Some of the monitors included other components that are known to be motivating, such as social rewards, badges and social support," Lyons said.

On the other hand, only a few of the apps included problem solving or action planning, both considered effective parts of behavioral interventions.

"Hopefully we'll see more (action planning) as apps become more sophisticated - which they are rather rapidly," Lyons said. "Quite a few of the monitors added entirely new functionality, like energy balance tracking, weight tracking and sleep tracking, in (a short) period. Things are moving fast."

Lyons hopes to learn more about lifestyle monitors and already has started other studies on them.

"We have a study looking at the feasibility of using the Jawbone Up24 among adults (who are) 55-79 years old," Lyons said. "We'll be able to look at effectiveness by measuring all sorts of physiological and psychological outcomes."

Sleep was shown as a major factor, so Lyons and her team will study the accuracy of monitors for for tracking both activity and sleep.

"Though we didn't ask participants in the first study to measure their sleep, almost all of them took it upon themselves to do it anyway," Lyons said. "Many told us that the study greatly improved their sleep, both by the tracking and because of their increased activity."

Lyons has collaborated with Sara Nowakowski, a UTMB sleep researcher, to use the monitors in other ways.

"Since both activity and sleep affect weight, and almost all of my participants want to improve all three, it seems like a good idea," Lyons said.

As for the future of activity monitors, McQuillin sees phone technology as a key part of their future. For example, Apple's newest iPhone software, iOS 8, already has a built-in health app.

"I could see a smart watch taking the place of (other activity monitors) depending on how well they work," McQuillin said. "My suspicion is that the technology will be acquired and integrated."